股骨转子间骨折股骨近端防旋髓内钉固定围术期重复静脉应用氨甲环酸的作用

Effect of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation for femoral intertrochanteric fracture

背景:股骨转子间骨折股骨近端防旋髓内钉内固定围术期应用氨甲环酸的最佳用法仍无统一标准。目的:探讨股骨转子间骨折患者股骨近端防旋髓内钉固定围术期重复静脉应用氨甲环酸的作用及安全性。方法:选择2017年9月至2020年6月在徐州医科大学附属医院行股骨近端防旋髓内钉内固定治疗股骨转子间骨折的患者共100例,随机分成3组。单次给药组33例患者在术前半小时给予氨甲环酸1.0g静脉滴注;重复给药组35例患者术前同单次给药组给药,术后3,6h重复静脉滴注氨甲环酸1.0 g;对照组32例术前半小时给予等量生理盐水。收集3组患者基线资料、手术时间、术中出血量、术后引流量、围术期血红蛋白、红细胞压积、C-反应蛋白、白细胞介素6水平,术前及术后7 d行下肢深静脉彩超检查,计算围术期总失血量、隐性失血量和血栓发生率。结果与结论:①重复给药组患者总失血量(499.20±189.80) mL,明显低于单次给药组(722.33±241.76) mL和对照组(859.41±165.03) mL,差异有显著性意义(P <0.05);重复给药组患者隐性失血量(359.03±208.57) mL明显低于单次给药组(544.73±290.69) mL和对照组(719.22±204.08) mL,差异有显著性意义(P <0.05);②术后3组C-反应蛋白和白细胞介素6水平比较,术后重复给药组炎症指标最低,对照组炎症指标最高,差异有显著性意义(P <0.05);③3组患者无肺栓塞发生,下肢血栓均为无症状的肌间静脉血栓,其中对照组2例(2/32),单次给药组4例(4/33),重复给药组3例(3/35),3组间差异无显著性意义(P <0.05);④提示股骨近端防旋髓内钉内固定围术期重复应用氨甲环酸可进一步减少围术期隐性失血量,具有潜在的抗炎作用,且不增加患者血栓发生风险。

OBJECTIVE:To investigate the effect and safety of repeated intravenous tranexamic acid in the perioperative period of proximal femoral nail antirotation in patients with femoral inte rtrochanteric fracture.METHODS:Totally 100 patients with intertrochanteric fracture treated by proximal femoral nail antirotation in the Affiliated Hospital of Xuzhou Medical University from September 2017 to June 2020 were randomly divided into three groups.In the single-dose group,33 patients were given tranexamic acid 1.0 g intravenously half an hour before ope ration.In the repeated-dose group,35 patients were given the same medicine as the single-dose group before operation,and repeated intravenous drip of tranexamic acid 1.0 g at 3 and 6 hours after operation.In the control group,32 patients were given an equal volume of physiological saline half an hour before operation.The baseline data,operation tim e,intraoperative blood loss,postoperative drainage volume,perioperative hemoglobin,hematocrit,C-reactive protein and interleukin-6 were collected from the three groups.Color Doppler ultrasound examination of lower extremity deep vein was conducted;and the total blood loss,hidden blood loss and thro m bosis rate were calculated before and 7 days after operation.RESULTS AND CONCLUSION:(1)Total blood loss was significantly lower in the repeated-dose group(499.20±189.80)mL than that in the single-dose group(722.33±241.76)mL and control group(859.41±165.03)mL(P<0.05).The hidden blood loss was significantly lower in the repeated-dose group(359.03±208.57)mL than that in the single-dose group(544.73±290.69)mL and control group(719.22±204.08)mL(P<0.05).(2)Compared with C-reactive protein and interleukin-6 in three groups after operation,the inflammatory indexes in repeated-dose group were the lowest and those in the control group were the highest(P<0.05).(3)There was no pulmonary embolism in the three groups,and the lower extremity thrombosis was asymptomatic intermuscular venous thrombosis.There were two cases(2/32)in the control group,four cases(4/33)in single-dose group,and three cases(3/35)in repeated-dose group.The difference was not statistically significant(P<0.05).(4)It is indicated that repeated use of tranexamic acid in the pe riope rative period of proximal femoral nail antirotation can further reduce the hidden blood loss,and reduce the inflammatory reaction without increasing the risk of thrombosis.